From the Guidelines
Transient Ischemic Attack (TIA) symptoms include sudden weakness or numbness on one side of the body, slurred speech, difficulty understanding others, vision changes, dizziness, and severe headache, and management requires urgent medical attention with antiplatelet therapy and risk factor management to prevent future stroke. The symptoms of TIA are typically transient, resolving within 24 hours, but the condition is a warning sign for potential future stroke.
Common Symptoms of TIA
- Sudden weakness or numbness on one side of the body
- Slurred speech
- Difficulty understanding others
- Vision changes
- Dizziness
- Severe headache
Management of TIA
Management of TIA involves urgent medical attention, with initial assessment including brain imaging (CT or MRI), carotid ultrasound, and cardiac evaluation.
Antiplatelet Therapy
Treatment typically involves antiplatelet therapy such as aspirin (325mg initially, then 81mg daily) 1, clopidogrel (75mg daily), or a combination of aspirin and extended-release dipyridamole.
Anticoagulation
In cases of atrial fibrillation, anticoagulation with medications like warfarin, apixaban, or rivaroxaban is recommended 1.
Risk Factor Management
Risk factor management is crucial, including:
- Blood pressure control (target <130/80 mmHg) 1
- Cholesterol management with statins (atorvastatin 40-80mg or rosuvastatin 20-40mg daily) 1
- Diabetes control
- Smoking cessation
- Lifestyle modifications including regular exercise and a Mediterranean or DASH diet
Surgical Interventions
Surgical interventions like carotid endarterectomy may be considered for significant carotid stenosis. TIAs require immediate attention because they indicate underlying vascular problems that, if left untreated, significantly increase the risk of a full stroke within days to weeks following the initial event.
From the Research
Symptoms of Transient Ischemic Attack (TIA)
- Transient, sudden-onset focal neurological symptoms which usually completely and rapidly resolve by presentation 2
- Symptoms vary widely from patient to patient, depending on the area of the brain involved 3
- No permanent damage due to short-lived blockage period 3
Risk Factors for TIA
- Family history of stroke or TIA 3
- Age above 55 years or older 3
- Higher risk of TIA in males than females 3
- High blood pressure 3
- Diabetes mellitus 3
- Tobacco smoking 3
- Genetics, race, and imbalance in lipid profile 3
Management of TIA
- Time critical investigations and management, as well as service organisation remain key to achieving good outcomes 2
- Essential investigations for all patients with TIA should include early brain imaging, ECG, and carotid imaging in patients with anterior circulation symptoms 2
- Immediate administration of an antiplatelet agent 2
- Subsequent attention to other mechanistic factors can be managed safely as part of a structured clinical pathway supervised by stroke specialists 2
- Rapid investigation and management to prevent stroke 4
- Treatment following acute recovery from a TIA depends on the underlying cause 3
- Patients who have more than 70% stenosis of the carotid artery, removal of atherosclerotic plaque is usually done by carotid endarterectomy surgery 3
- Antiplatelet therapy with aspirin or clopidogrel is common practice to lower the risk of recurrent stroke or death 5
- Combination of aspirin plus dipyridamole may be superior to aspirin alone in TIA or minor stroke patients 5